Thyroid Testing

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Functional Thyroid Testing

There are many different thyroid tests that are relevant to diagnose thyroid disease, assess treatment success, and manage medication dosage. 

This page will discuss both conventional and non-conventional tests commonly used for thyroid assessment and disease diagnosis. You will learn about other testing options available to you if you have had standard testing yet are still struggling with symptoms and disease progression.

Very rarely, babies are born without a working thyroid gland. For this reason, all Australian newborns are screened for hypothyroidism with a TSH test using a drop of blood taken from a heel prick.

Will Medicare cover my testing? (The Lucy Rose Clinic does not offer Medicare rebates)

As with many Medicare services, you need to meet specific criteria for testing:

  • You must have symptoms that could be linked to your thyroid function.
  • A doctor will need to certify that the test is medically necessary.
  • You must get the test from a Medicare-approved laboratory.

Some of the reasons you might need a thyroid test include:

    • You have a goiter or nodule on your thyroid.
    • You’re experiencing symptoms of hypothyroidism (too little thyroid hormone)
    • You’re experiencing symptoms of hyperthyroidism (too much thyroid hormone)
    • You already take thyroid medication and your GP needs to assess your dose. Usually, only TSH and fT4 will be repeated, even if you have been diagnosed with Hashimoto’s.

*Information supplied is for educational purposes only and not intended to diagnose or treat a condition. Refer to your medical professional.

 

Symptoms of Hyperthyroidism

  • Racing heart and/or heart palpitations
  • Weight loss
  • Irritability
  • Fatigue and insomnia
  • Brittle nails
  • Shakiness
  • Diarreogh
  • Irregular menstrual periods
  • Hair thinning (or loss of hair)
  • Shortness of breath
  • Intolerance to heat (feeling hotter than others)
  • Hair thinning (or loss of hair)

Symptoms of Hypothyroidism

  • Difficulty with Math
  • Hoarse or Deeper Voice
  • Constipation
  • Coarse Hair/Hair Loss/Brittle
  • Muscle / Joint Pain
  • Low Sex Drive / Impotence
  • Puffy Hands and Feet
  • Unsteady Gait
  • Gain Weight Easy
  • Outer Third of Eyebrows sparse hair
  • Menses More Irregular
  • Heavier Menses
  • Carpal Tunnel Syndrome
  • Tiredness & Sluggishness
  • Dryer Hair or Skin
  • Sleep More Than Usual
  • Weaker Muscles
  • Constant Feeling of Cold
  • Frequent Muscle Cramps
  • Poorer Memory
  • More Depressed
  • Slower Thinking
  • Puffier Eyes

Testing and Investigation

Thyroid function tests are blood tests used to screen for suspected thyroid problems. The first test run is usually thyroid-stimulating hormone (TSH), then if that is out of range, thyroxine (T4), and triiodothyronine (T3).

Thyroid antibody tests may be run if thyroid tissue appears inflamed to diagnose an autoimmune disease. (See Grave’s disease or Hashimoto’s disease for more information)

The Lucy Rose Clinic will run more markers to identify the root cause of the presenting symptoms, plus understand how the thyroid hormone conversion is operating. These tests include reverse T3 and SHBG (sex hormone binding globulin). Full panels of nutritional markers, iodine studies, cardiovascular testing, inflammatory status, hormone status, and adrenal status are run for a full functional overview of the body.

From a Naturopathic perspective, we are not trying to diagnose a disease but to understand how and why a thyroid system may be malfunctioning. 

Increased production of rT3 is often seen in patients with disorders such as fibromyalgia, chronic fatigue syndrome (CFS), Wilson’s Thyroid Syndrome, and stress. Measurement of rT3 is also valuable in identifying sick euthyroid syndrome where active T3 is within normal range and rT3 is elevated. Reverse T3—According to Dr.Holtorf rT3 should be less than 250. To learn more about these thyroid tests, Click Here.

Below see a Functional Thyroid Test Result demonstrating the difference between ‘NORMAL’ and ‘OPTIMAL’ reference ranges. Optimal reference ranges result in zero thyroid-related symptoms, and this is the goal for our patients.

 

Medical Thyroid Testing and Investigation

Thyroid nuclear scan

A thyroid nuclear scan is used to help determine the cause of the excess thyroid hormone. This scan involves injecting a small amount of radioactive substance into a vein in the arm. After 20 minutes, images are taken of the thyroid (neck) area by a special gamma camera that provides information about the function and structure of the thyroid gland. These images require about 20 minutes to take.

This scan can also help in distinguishing between benign (non-cancerous) and malignant (cancerous) thyroid nodules or lumps.

This scan uses a radioactive substance, so is not suitable for pregnant or breastfeeding women. Some other pre-existing conditions may also prevent you from having a radioactive scan. Your doctor can discuss this with you.

Thyroid ultrasound

This is a non-invasive imaging method that uses sound waves to take pictures of the thyroid gland and surrounding neck structures such as lymph nodes. It allows measurements to be made of the size of the thyroid gland, and of any thyroid nodules together with a description of what the nodules look like.

Treatments

Medical Treatment

Thyroid replacement medications

If your thyroid hormone production is too low, a thyroid medication (thyroxine) may be given. This medication increases the blood level of thyroid hormones. Regular blood tests will be ordered by your doctor to check hormone levels are returning to a normal range.

Radioactive iodine

Radioactive iodine may be used to reduce thyroid hormone production by destroying some or all of the thyroid gland. For most patients, this is a single treatment, taken as a pill that releases radioactive iodine. The thyroid gland absorbs the iodine, and the radiation damages and destroys the overactive thyroid cells.

Surgery

If too much thyroid hormone is being produced by the thyroid gland which cannot be controlled by an anti-thyroid medication or radioactive iodine treatment, surgery is generally recommended. For Graves’ disease, surgery involves removing all the thyroid gland – ‘total thyroidectomy’, also called TT. After a total thyroidectomy, lifelong thyroid hormone replacement therapy will be needed so that your body gets enough thyroid hormone to keep functioning.

Image depicting Hashimotos disease symptoms

Integrative Treatment

If thyroid tests are not outside of range enough to warrant medication, functional medicine may be able to reverse the disease with a corrective approach and prevent the need for future medication. This is the optimal approach, as people on thyroid medication still will suffer from more health challenges even when the medication dose is correct.

For those already on medication, thyroid treatment can be combined with natural medicine treatments for potentially better patient outcomes. Patients that work integratively like this experience fewer side effects to medical treatments, and experience better symptom management.

Some patients wish to try natural medicine first, before resorting to a permanent procedure such as a total thyroidectomy, in which case a fully holistic treatment model is designed for them based on current pathology, symptom picture, and history.

Nutritional Medicine

Common deficiencies that contribute to autoimmune thyroid disease include iodine, zinc, vitamin D3, magnesium, B12, and active folate (L-Methylfolate). A functional health practitioner can test for vitamin and mineral deficiencies so these can be adequately treated.

Diet

A gluten and dairy-free diet can help reduce inflammation and aid in reducing autoimmune antibodies. It is also useful to avoid any foods that specifically cause inflammation in your body (which can be detected by doing a food intolerance test).

Herbal Medicine

Botanical medicines can also help in “immune modulation” – that is, to help the immune system recognise self- from foreign antigens, and stop attacking its own tissues. Generally, a holistic approach is required to treat Graves’ disease with natural medicine, which includes diet modification, stress management, and herbal medicine.

Adrenal support is essential to help reduce stress levels, as stress is a well-recognised driver of autoimmune disease. We run 3-point saliva testing to assess adrenal hormone function, and sleep/insomnia. Click Here to learn more.

References:

The incidence of Graves’ ophthalmopathy in Olmsted County, Minnesota. Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, Gorman CA, Am J Ophthalmol. 1995;120(4) 511. 

Occurrence of ophthalmopathy after treatment for Graves’ hyperthyroidism. The Thyroid Study Group. Tallstedt L, Lundell G, Tørring O, Wallin G, Ljunggren JG, Blomgren H, Taube A, N Engl J Med. 1992;326(26) 1733. 

Vogel A, Elberling TV, Hørding M, et al. (January 2007). “Affective symptoms and cognitive functions in the acute phase of Graves’ thyrotoxicosis”. Psychoneuroendocrinology 32 (1): 36–43. doi:10.1016/j.psyneuen.2006.09.012. PMID 17097812. 

Bunevicius R, Velickiene D, Prange AJ; Velickiene; Prange Jr (2005). “Mood and anxiety disorders in women with treated hyperthyroidism and ophthalmopathy caused by Graves’ disease”.Gen Hosp Psychiatry 27 (2): 133–9. doi:10.1016/j.genhosppsych.2004.10.002. PMID 15763125. 

Studies on thyrotrophin receptor antibodies in patients with euthyroid Graves’ disease. Kasagi K, Hatabu H, Tokuda Y, Iida Y, Endo K, Konishi J, Clin Endocrinol (Oxf). 1988;29(4) 357. 

Studies of thyroid function and immune parameters in patients with hyperthyroid Graves’ disease in remission. Murakami M, Koizumi Y, Aizawa T, Yamada T, Takahashi Y, Watanabe T, Kamoi K, J Clin Endocrinol Metab. 1988;66(1) 103. 

Chapter 11. Diagnosis and Treatment of Graves’ Disease Leslie J. De Groot, MD Professor of Medicine – 

http://www.thyroidmanager.org/Chapter11/chapter11.html Updated: March 5, 2008 

Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH, J Neurol Neurosurg Psychiatry. 2000;68(6) 750; Electromyographic and histological findings in the muscles of patients with thyrotoxicosis. HAVARD CW, CAMPBELL ED, ROSS HB, SPENCE AW, Q J Med. 1963;32:145; Electromyography in thyrotoxicosis. Ramsay ID, Q J Med. 1965;34(135) 255. 

i Wikipedia 2016, Hyperthyroidism. Available from: https://en.wikipedia.org/wiki/Hyperthyroidism . [22 June 2016]. 

ii Gilbert, J 2012, ‘Thyroid and Menopause’, British Thyroid Foundation. Available from: http://www.btf-thyroid.org/information/articles/107- thyroid-and-menopause . [23 June 2016 iii Gilbert, J 2012, ‘Thyroid and Menopause’, British Thyroid Foundation. Available from: http://www.btf-thyroid.org/information/articles/107- thyroid-and-menopause . [23 June 2016]. 

iv Norman, J 2016, ‘Diagnosing Hyperthyroidism: Overactivity of the Thyroid Gland’, Vertical Health. Available from: http://www.endocrineweb.com/conditions/hyperthyroidism/diagnosing-hyperthyroidism-overactivity-thyroid-gland . [22 June 2016]. v http://www.ncbi.nlm.nih.gov/pubmed/22934923 and http://www.naturalendocrinesolutions.com/articles/the-role-of-leptin-in-thyroid-health/ 

vi http://www.nitekmedical.com/studies.html 

vii Toft, DJ 2016, ‘Graves’ Disease Diagnosis’, Vertical Health. Available from: http://www.endocrineweb.com/conditions/graves-disease/graves- disease-diagnosis . [23 June 2016]. 

viii Natural Endocrine Solutions 2012, Is It Possible To Eliminate The Autoimmune Response In Graves Disease and Hashimoto’s Thyroiditis? Available from: http://www.naturalendocrinesolutions.com/archives/is-it-possible-to-eliminate-the-autoimmune-response-in-graves-disease-hashimotos- thyroiditis/ . [23 June 2016]. 

ix Thyroid : Official Journal of the American Thyroid Association Thyroid Autoantibodies (TPOAb, TgAb and TRAb) Thyroid. 2003;13(1) http://www.medscape.com/viewarticle/452668_7 

x WebMD 2016, Overactive Thyroid (Hyperthyroidism). Available from: http://www.webmd.com/women/overactive-thyroid- hyperthyroidism?page=3 . [23 June 2016]. 

https://www.healthline.com/health/medicare/does-medicare-cover-thyroid-tests#medicare-coverage